Human Weight Compensation With a Backdrivable Upper-Limb Exoskeleton: Identification and Control

Active exoskeletons are promising devices for improving rehabilitation procedures in patients and preventing musculoskeletal disorders in workers. In particular, exoskeletons implementing human limb’s weight support are interesting to restore some mobility in patients with muscle weakness and help in occupational load carrying tasks. The present study aims at improving weight support of the upper limb by providing a weight model considering joint misalignments and a control law including feedforward terms learned from a prior population-based analysis. Three experiments, for design and validation purposes, are conducted on a total of 65 participants who performed posture maintenance and elbow flexion/extension movements. The introduction of joint misalignments in the weight support model significantly reduced the model errors, in terms of weight estimation, and enhanced the estimation reliability. The introduced control architecture reduced model tracking errors regardless of the condition. Weight support significantly decreased the activity of antigravity muscles, as expected, but increased the activity of elbow extensors because gravity is usually exploited by humans to accelerate a limb downwards. These findings suggest that an adaptive weight support controller could be envisioned to further minimize human effort in certain applications.

Clinical Interpretation of Working Volume and Weight Support in Upper Limb Robotic Neurorehabilitation after Stroke

In the past two decades, many studies reported the efficacy of upper limb robotic rehabilitation in patients after stroke, also in its chronic phase. Among the possible advantages of robotic therapy over conventional therapy are the objective measurements of kinematic and kinetic parameters during therapy, such as the spatial volume covered by the patient’s upper limb and the weight support provided by the robot. However, the clinical meaning and the usability of this information is still questioned. Forty patients with chronic stroke were enrolled in this study and assessed at the beginning of upper limb robotic therapy (Armeo® Power) and after two weeks (ten sessions) of therapy by recording the working volume and weight support provided by the robot and by administering six clinical scales to assess upper limb mobility, strength, spasticity, pain, neurological deficits, and independency. At baseline, the working volume significantly correlated with spasticity, whereas weight support significantly correlated with upper limb strength, pain, spasticity, and neurological deficits. After two weeks of robotic rehabilitation, all the clinical scores as well as the two parameters improved. However, the percentage changes in the working volume and weight support did not significantly correlate with any of the changes in clinical scores. These results suggest caution in using the robotic parameters as outcome measures because they could follow the general improvement of the patient, but complex relationships with clinical features are possible. Robotic parameters should be analyzed in combination with the clinical scores or other objective measures because they may be informative about therapy progression, and there is a need to combine their clinical, neuroscientific, and biomechanical results to avoid misleading interpretations.

Physiotherapy management of children with cerebral palsy

Cerebral palsy (CP) is a non-progressive developmental movement and posture disorder that occurs during fetal or infant development. It results from an insult to the developing brain before birth, during delivery, or after birth. CP is regarded as the leading cause of childhood disability in all parts of the world. The hallmark of CP is a motor disability, thus, physiotherapy has long been central to the clinical management of children with this disorders. Physiotherapy intervention in the management of this condition focuses on function, movement, and optimizing the child’s potential. Some of the approaches used are neurodevelopmental technique, neuromuscular electrical stimulation, exercise therapy, hydrotherapy, body weight support tread mill training, sensory integration training, and constraints induced therapy. Although, physiotherapy is generally recommended by all members of the health-care team. However, the effectiveness of physiotherapy is inconsistent. The objective of this review was to summarize the proven effectiveness of the most commonly used physiotherapy intervention in the management of children with CP.

Prototype for Knee-load Relief through Ischiatic Support

Objective: The objective of this work was to develop a passive exoskeleton prototype for the relief of knee-load employing ischiatic body weight support. Methods and materials: A functional prototype was developed and tested with three volunteers to analyze its potential effectiveness and effects on gait kinematics. The performance of the prototype was assessed using motion capture and pressure mapping systems, and a testing bench for the study of ischiatic body weight. Results and discussion: The results of the tests indicate that the prototype allows reducing the load supported by the knees and does not have a significant effect on the kinematics of the hip and knee joints. The process allowed the designers to identify possibilities of improvement mainly on reducing the restrictions imposed by the prototype to the motion of the ankles, especially on the midstance of the support phase. Conclusions: The passive exoskeleton prototype developed for ischiatic body weight support allows setting different percentages of knee-load relief. The prototype does not have a significant effect on the kinematics of the hip and knee joints. Nevertheless, improvements must be performed to reduce the restrictions to the motion of the ankles.

Design, Manufacturing, and Control of a Pneumatic-Driven Passive Robotic Gait Training System for Muscle-Weakness in a Lower Limb

We designed and manufactured a pneumatic-driven robotic passive gait training system (PRPGTS), providing the functions of body-weight support, postural support, and gait orthosis for patients who suffer from weakened lower limbs. The PRPGTS was designed as a soft-joint gait training rehabilitation system. The soft joints provide passive safety for patients. The PRPGTS features three subsystems: a pneumatic body weight support system, a pneumatic postural support system, and a pneumatic gait orthosis system. The dynamic behavior of these three subsystems are all involved in the PRPGTS, causing an extremely complicated dynamic behavior; therefore, this paper applies five individual interval type-2 fuzzy sliding controllers (IT2FSC) to compensate for the system uncertainties and disturbances in the PRGTS. The IT2FSCs can provide accurate and correct positional trajectories under passive safety protection. The feasibility of weight reduction and gait training with the PRPGTS using the IT2FSCs is demonstrated with a healthy person, and the experimental results show that the PRPGTS is stable and provides a high-trajectory tracking performance.

Likelihood and Its Applications

The chapter “Likelihood and Its Applications” introduces the likelihood concept and the concept of maximum likelihood estimation of model parameters. Likelihood is the link between data and models. It is used to estimate model parameters, judge the degree of precision of parameter estimates, and weight support for alternative models. Likelihood is therefore a crucial concept that underlies the ability to test multiple models. The chapter contains several worked examples that progress the reader through increasingly complex problems, ending at likelihood profiles for models with multiple parameters. Importantly, it illustrates how one can take any dynamic model and data and use likelihood to link the data (random variables) to a probability function that depends on the dynamic model.